Michigan Diabetic Neuropathy Score

Sensory impairment
Right	Normal	Decreased	Absent
Vibration at big toe	0	1	2
10-g filament	0	1	2
Pin prick on dorsum of great toe	Painful	Not Painful
Pin prick on dorsum of great toe	0	2
Left	Normal	Decreased	Absent
Vibration at big toe	0	1	2
10-g filament	0	1	2
Pin prick on dorsum of great toe	Painful	Not Painful
Pin prick on dorsum of great toe	0	2
Muscle strength testing
Right	Normal	Mild to moderate	Severe	Absent
Finger spread	0	1	2	3
Great toe extension	0	1	2	3
Ankle dorsiflexion	0	1	2	3
Left	Normal	Normal	Severe	Absent
Finger spread	0	1	2	3
Great toe extension	0	1	2	3
Ankle dorsiflexion	0	1	2	3
Reflexes
Right	Present	Present with reinforcement	Absent
Biceps brachii	0	1	2
Triceps brachii	0	1	2
Quadriceps femoris	0	1	2
Achilles	0	1	2
Left	Present	Present with reinforcement	Absent
Biceps brachii	0	1	2
Triceps brachii	0	1	2
Quadriceps femoris	0	1	2
Achilles	0	1	2
Total: 46 points

The findings from the clinical examination are scored on this form. Nerve conduction studies (of sural, peroneal motor, median sensory and motor, and ulnar sensory nerves) are graded separately. A composite score is then derived, based upon the number of points scored on the clinical examination (this form) and the number of abnormal nerve conductions.

Adapted from: Feldman EL, Stevens MJ, Thomas PK, et al. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994; 17:1281.

Graphic 50683 Version 4.0

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Michigan Diabetic Neuropathy Score